An Acute Care Surgery Model Improves Timeliness of Care and Reduces Hospital Stay for Patients with Acute Cholecystitis

2011 ◽  
Vol 77 (10) ◽  
pp. 1318-1321 ◽  
Author(s):  
Briana Lau ◽  
L. Andrew Difronzo
Keyword(s):  
Acute Cholecystitis ◽  
Acute Care ◽  
Acute Care Surgery ◽  
Complication Rates ◽  
Significant Difference ◽  
After Hours ◽  
Timeliness Of Care ◽  
Care Surgery ◽  
The Impact ◽  
Length Of Hospitalization

In October 2009, an acute care surgery (ACS) model was implemented to facilitate urgent surgical consults. This study examines the impact of ACS on the timeliness of care and length of hospitalization for patients with acute cholecystitis. A retrospective cohort study was performed of patients presenting to the emergency department (ED) with acute cholecystitis who underwent early cholecystectomy. Patients with choledocholithiasis, pancreatitis, biliary colic, or cholelithiasis without cholecystitis were excluded. There were two study cohorts: ACS (October 2009 to July 2010) and pre-ACS (October 2008 to September 2009). Primary outcome measures were length of stay (LOS) and time from the ED to the operating room (OR). One hundred fifty-two cases were identified: 71 in the ACS group and 81 in the pre-ACS group. Patient demographics were similar. The ACS group had a significantly shorter average time from the ED to the OR (24.6 vs 35.0 hours, P = 0.0276). Overall LOS was reduced by a mean of 14.7 hours in the ACS group (mean 3.23 vs 2.63 days, P = 0.11). There was no significant difference in OR time (2.45 vs 2.38 hours, P = 0.562). There was a significant decrease in after-hours cases in the ACS group (5.6 vs 21%, P = 0.004) and a decrease in complication rates (18.5 vs 7.0%, P = 0.032). In conclusion, the ACS model decreased time from the ED to the OR, decreased after-hours cases, decreased length of hospitalization, and decreased complications for patients with acute cholecystitis.

scholarly journals The impact of an acute care surgery model on general surgery service productivity

2018 ◽  
Vol 12 ◽  
pp. 26-30 ◽  
Author(s):  
Adam N. Paine ◽  
Bradley L. Krompf ◽  
Edward C. Borrazzo ◽  
Thomas P. Ahern ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Acute Care ◽  
General Surgery ◽  
Acute Care Surgery ◽  
Service Productivity ◽  
Care Surgery ◽  
The Impact

Acute care surgery: the impact of an acute care surgery service on assessment, flow, and disposition in the emergency department

2012 ◽  
Vol 203 (5) ◽  
pp. 578-583 ◽  
Author(s):  
Chad G. Ball ◽  
Anthony R. MacLean ◽  
Elijah Dixon ◽  
May Lynn Quan ◽  
Lynn Nicholson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Acute Care Surgery ◽  
Care Surgery ◽  
The Impact

scholarly journals After hours surgery and mortality: the potential role of acute care surgery models as a factor accounting for results

2017 ◽  
Vol 189 (5) ◽  
pp. E219-E219
Author(s):  
David R. Lardner ◽  
Carmen A. Brauer ◽  
A. Rob Harrop ◽  
Ali MacRobie
Keyword(s):  
Acute Care ◽  
Potential Role ◽  
Acute Care Surgery ◽  
After Hours ◽  
Care Surgery

scholarly journals Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Gun-Hee Yi ◽  
Hak-Jae Lee ◽  
Seul Lee ◽  
Jong-Hee Yoon ◽  
Suk-Kyung Hong
Keyword(s):  
Acute Appendicitis ◽  
South Korea ◽  
Hospital Stay ◽  
Acute Care ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Acute Care Surgery ◽  
Medical Procedure ◽  
Complication Rates ◽  
Care Surgery

Abstract Background The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.Results In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).Conclusions Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

scholarly journals Robotic Subtotal Cholecystectomy in a Geriatric Acute Care Surgery Patient with Super Obesity

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Diane Bronikowski ◽  
Dominic Lombardo ◽  
Connie DeLa’O ◽  
Nova Szoka
Keyword(s):  
Acute Cholecystitis ◽  
Acute Care ◽  
The Body ◽  
Acute Care Surgery ◽  
Super Obesity ◽  
Perioperative Morbidity ◽  
Subtotal Cholecystectomy ◽  
Duct Occlusion ◽  
Tube Removal ◽  
Care Surgery

Introduction. Unique challenges exist with conventional laparoscopic operations in patients with super obesity ( BMI > 50 ). Limited literature is available regarding use of the robotic platform to treat patients with super obesity or acute care surgery patients. This case describes an interval robotic subtotal cholecystectomy in an elderly patient with super obesity and multiple comorbidities. Case Description. A 74-year-old male with a BMI of 59.9 developed acute cholecystitis. He was deemed excessively high risk for operative intervention due to concurrent comorbid conditions and underwent percutaneous cholecystostomy. After a few months, a cholangiogram demonstrated persistent cystic duct occlusion. The patient expressed interest in tube removal and elective interval cholecystectomy. After preoperative risk stratification and optimization, he underwent a robotic subtotal cholecystectomy with near infrared fluorescence cholangiography. The patient was discharged on postoperative day one and recovered without complications. Discussion. Obesity is a risk factor for acute cholecystitis, which is most commonly treated with conventional laparoscopy (CL). CL is technically restraining and difficult to perform in patients with super obesity. The body habitus of patients with super obesity can impair proper instrumentation and increase perioperative morbidity. In this case, robotic assisted cholecystectomy console improved surgeon ergonomics and provided support for proper instrumentation. Robotic, minimally invasive cholecystectomy approaches may reduce perioperative morbidity in patients with super obesity. Further studies are necessary to address the role of robotic surgery in acute care surgery patients with super obesity.

The Implications of Transfer to an Acute Care Surgical Tertiary Service

2017 ◽  
Vol 83 (12) ◽  
pp. 1422-1426 ◽  
Author(s):  
Rebecca Britt ◽  
Pamela Davis ◽  
Anjali Gresens ◽  
Leonard Weireter ◽  
T.J. Novosel ◽  
...  
Keyword(s):  
Acute Care ◽  
Surgical Care ◽  
Acute Care Surgery ◽  
Billing Data ◽  
Free Standing ◽  
Hospital Transfer ◽  
Tertiary Hospitals ◽  
Transfer Group ◽  
Care Surgery ◽  
The Impact

Tertiary hospitals are increasingly called on by smaller hospitals and free-standing emergency rooms (ERs) to provide surgical care for complex patients. This study assesses patients transferred to an acute care surgery service. The ER and transfer center logs, as well as billing data, were reviewed for 12 months for all cases evaluated by acute care surgery. The charts were reviewed for demographics, comorbidities, and outcomes. A total of 111 transferred patients with complete data were identified, with 59 transferred from another hospital and 52 from a free-standing ER. The hospital transfer patients were older with more comorbidities, had a longer length of stay, and were more likely discharged to skilled care. There was no difference in the percent of patients requiring a procedure; however, significantly more procedures in the hospital transfer group were done by nonsurgical specialties Better infrastructure to monitor the impact of hospital transfers is warranted in the setting of the complex patient population transferred to tertiary hospitals.

scholarly journals Development of an acute care surgery service in Rwanda

2019 ◽  
Vol 4 (1) ◽  
pp. e000332 ◽  
Author(s):  
Egide Abahuje ◽  
Isaie Sibomana ◽  
Elisee Rwagahirima ◽  
Christian Urimubabo ◽  
Robert Munyaneza ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Acute Care ◽  
Epidemiologic Study ◽  
Length Of Hospital Stay ◽  
Acute Care Surgery ◽  
Level Of Evidence ◽  
Midline Laparotomy ◽  
Resource Setting ◽  
Care Surgery ◽  
The Impact

BackgroundAcute care surgery (ACS) encompasses trauma, critical care, and emergency general surgery. Due to high volumes of emergency surgery, an ACS service was developed at a referral hospital in Rwanda. The aim of this study was to evaluate the epidemiology of ACS and understand the impact of an ACS service on patient outcomes.MethodsThis is a retrospective observational study of ACS patients before and after introduction of an ACS service. χ2 test and Wilcoxon rank-sum test were used to describe the epidemiology and compare outcomes before (pre-ACS)) and after (post-ACS) implementation of the ACS service.ResultsData were available for 120 patients before ACS and 102 patients after ACS. Diagnoses included: intestinal obstruction (n=80, 36%), trauma (n=38, 17%), appendicitis (n=31, 14%), and soft tissue infection (n=17, 8%) with no difference between groups. The most common operation was midline laparotomy (n=138, 62%) with no difference between groups (p=0.910). High American Society of Anesthesiologists (ASA) score (ASA ≥3) (11% vs. 40%, p<0.001) was more common after ACS. There was no difference in intensive care unit admission (8% vs. 8%, p=0.894), unplanned reoperation (22% vs. 13%, p=0.082), or mortality (10% vs. 11%, p=0.848). The median length of hospital stay was longer (11 days vs. 7 days, p<0.001) before ACS.ConclusionsAn ACS service can be implemented in a low-resource setting. In Rwanda, ACS patients are young with few comorbidities, but high rates of mortality and morbidity. In spite of more patients who are critically ill in the post-ACS period, implementation of an ACS service resulted in decreased length of hospital stay with no difference in morbidity and mortality.Level of evidencePrognostic and epidemiologic study type, level III.

QS433. Initial Implementation of an Acute Care Surgery Model: Implications for Timeliness of Care

2009 ◽  
Vol 151 (2) ◽  
pp. 302
Author(s):  
R.C. Britt ◽  
L.J. Weireter ◽  
T.J. Novosel ◽  
S.F. Reed ◽  
J.N. Collins ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Surgery ◽  
Initial Implementation ◽  
Timeliness Of Care ◽  
Care Surgery
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